Caregiver perceptions of child development in rural Madagascar: a cross-sectional study

Abstract

Background Human capital (the knowledge, skills, and health that accumulate over life) can be optimized by investments in early childhood to promote cognitive and language development. Parents and caregivers play a crucial role in the promotion and support of cognitive development in their children. Thus, understanding caregiver perceptions of a child’s capabilities and attributes, including intelligence, may enhance investments early in life. To explore this question, we asked caregivers to rank their child’s intelligence in comparison with other children in the community, and compared this ranking with children’s scores on an assessment of developmental abilities across multiple domains. Methods Our study examined cross-sectional data of 3361 children aged 16–42 months in rural Madagascar. Child intelligence, as perceived by their caregiver, was captured using a ladder ranking scale based on the MacArthur Scale for Subjective Social Status. Children’s developmental abilities were assessed using scores from the Ages and Stages Questionnaire: Inventory (ASQ-I), which measures cognitive, language, and socio-emotional development. Ranked percentiles of the ASQ-I were generated within communities and across the whole sample. We created categories of under-estimation, matched, and over-estimation by taking the differences in rankings between caregiver-perceived child intelligence and ASQ-I. Child nutritional status, caregiver belief of their influence on child intelligence, and sociodemographic factors were examined as potential correlates of discordance between the measures using multinomial logistic regressions. Results We found caregiver perceptions of intelligence in Madagascar did not align consistently with the ASQ-I, with approximately 8% of caregivers under-estimating and almost 50% over-estimating their children’s developmental abilities. Child nutritional status, caregiver belief of their influence on child intelligence, caregiver education, and wealth were associated with under- or over-estimation of children’s developmental abilities. Conclusions Our findings suggest parents may not always have an accurate perception of their child’s intelligence or abilities compared with other children. The results are consistent with the limited literature on parental perceptions of child nutrition, which documents a discordance between caregiver perceptions and objective measures. Further research is needed to understand the common cues caregivers that use to identify child development milestones and how these may differ from researcher-observed measures in low-income settings. Trial registration Current Controlled Trials ISRCTN14393738. Registered June 23, 2015.

Home stimulation, development, and nutritional status of children under 2 years of age in the highlands of Madagascar

“…Mothers appeared to be more aware of the links between parent–child interaction and child development than fathers. Parents able to make the link between interactions with their child and the child’s development are more likely to engage in practices that promote stimulation [ 33 ]. Fathers could benefit from sensitization regarding the connection between positive stimulation and their children’s development and the same message could be reinforced among mothers.…”

Assessing Parenting Interactions With Children: Spanish Validation of PICCOLO With Fathers

“…Since the Teaching behaviors assessed with PICCOLO have shown to be related to the child's cognitive and linguistic development at early ages, both in typically developing children and in children with disabilities (Roggman et al, 2013a;Vilaseca et al, 2019a), the lesser presence of Teaching behaviors when interacting with children at early stages of development is particularly relevant for intervention programs with families with a child with developmental delays or disabilities, or a child at risk. Interestingly, research shows that parents may tend to underestimate their children's abilities (Chung et al, 2019), and may therefore desist from carrying out certain Teaching behaviors considered to be beyond them. Therefore, promoting and supporting parents' Teaching should receive special attention in early intervention and childcare programs.…”

Measurement Tools of Pediatric Nutrition and Health Suitable or Adaptable for Low- and Middle-Income Countries in Field Research Settings

“…Other potential shortcomings include parental misunderstanding of questions, over-reporting of more prominent symptoms, and underreporting less prominent and/or chronic symptoms [4]. Another possible source of error is reporting bias, as indicated by observed discordances between parent reports of their child's health and that assessed by a field health provider [5][6][7]. Some of these differences in assessment may arise due to social desirability bias and may vary with regional, cultural, socioeconomic, and educational differences, making cross-country comparisons difficult.…”

“…Standardized developmental tests or parental child development reports are widely used to assess neurodevelopment; however, results are not always validated in each cultural context. Standardized tests are training-intensive, prone to bias, difficult to standardize, and potentially expensive due to training and translation requirements, while parental child development reports may be inaccurate [6,113]. Thus, more objective, physiologic measures of neurodevelopment are needed [113].…”